| Xl-med Pc | |
|
25-15 Fair Lawn Ave Fair Lawn NJ 07410-3434 | |
| (201) 475-1005 | |
| (201) 475-1009 |
| Full Name | Xl-med Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 25-15 Fair Lawn Ave, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Olga Lishko (PRESIDENT) |
| Authorized Official Contact | 2014751005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Xl-med Pc 17-17 Greenwood Dr Fair Lawn NJ 07410-4533 Ph: (201) 475-1005 | Xl-med Pc 25-15 Fair Lawn Ave Fair Lawn NJ 07410-3434 Ph: (201) 475-1005 |
| NPI Number | 1588706725 |
|---|---|
| Provider Enumeration Date | 02/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6305945247 |
|---|---|
| Medicare Enrollment ID | O20070619000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588706725 | NPI | - | NPPES |
| 8503702 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MA67105 (New Jersey) | Primary |
| Provider Name | Olga V Lishko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710940317 PECOS PAC ID: 5991896201 Enrollment ID: I20070801000028 |
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